title: Management of intra-Descemet membrane air bubble in big-bubble deep anterior lamellar keratoplasty.
abstract: OBJECTIVE
  To report the recognition and management of intra-Descemet membrane air bubble (IDMA) as a complication of big-bubble deep anterior lamellar keratoplasty (DALK).
  
  
  METHODS
  IDMA was present intraoperatively in 8 eyes after DALK. Indications for surgery were healed keratitis (n = 4), macular dystrophy (n = 2), and keratoconus (n = 2). The IDMA was present between the anterior banded layer and posterior nonbanded layer of Descemet membrane (DM). They were slid and displaced toward the peripheral cornea using 27-gauge cannula and punctured taking care that underlying DM was not ruptured.
  
  
  RESULTS
  DM was bared in all eyes, and DALK was completed in 7 cases. One patient required conversion to penetrating keratoplasty because of macroperforation. No case had double anterior chamber. Mean follow-up was 13.9 ± 4.1 months. A DM fold was noted in 1 eye. Seven cases had postoperative best-corrected visual acuity of 20/60 or better.
  
  
  CONCLUSIONS
  Prompt recognition of the IDMA intraoperatively is required, which can be managed successfully.
authors.affiliation: Departments of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. namrata.sharma@gmail.com
authors.forename: Namrata
authors.initials: N
authors.lastname: Sharma
authors.forename: Rishi
authors.initials: R
authors.lastname: Swarup
authors.forename: Shveta Jindal
authors.initials: SJ
authors.lastname: Bali
authors.forename: Prafulla
authors.initials: P
authors.lastname: Maharana
authors.forename: Jeewan S
authors.initials: JS
authors.lastname: Titiyal
authors.forename: Rasik B
authors.initials: RB
authors.lastname: Vajpayee
mesh_terms: D000293:Adolescent; D000328:Adult; D000388:Air; D002648:Child; D003316:Corneal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016039:Corneal Transplantation / Q000009:adverse effects*; D003886:Descemet Membrane / Q000473:pathology*; D006801:Humans; D007431:Intraoperative Complications; D045423:Microbubbles; D008875:Middle Aged; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult